Therapeutics - Infectious disease 9
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What are the major uses for Clindamycin (Cleocin)?
- B. fragilis – 66% effective
- Clostridia – 80% effective
- Toxic shock – inhibit protein synthesis production
- Adjunctive for Pneumocystis; toxoplamosis
- Tx – community acquired MRSA infx (NOT EMPIRIC)
What is a normal dose for Clindamycin (Cleocin)?
- 150-450 PO Q6-8H
- 600-900 mg IV Q8H
What happens if you give a dose of Clindamycin (Cleocin) that is greater than 450 mg Q6-8H?
What should you monitor for when you give Clindamycin (Cleocin)?
- Contact a physician if diarrhea gets worse = indicating C. diff
What is the MOA of Sulfamethazole/Trimethoprim?
Bacterial folic acid synthesis in two different ways
What is the spectrum of Sulfamethazole/Trimethoprim?
- G +: MRSA, MSSA, Strep, Listeria
- G -: Enterobacteriaciae, E. coli, H. flu, Streptrophomonas
- Other: Pneumocytis jiroveci, Nocardia (Drug of choice for last 2), Toxoplasma, Legionella
- Legionella = not first choice
What is the MOA of metronidazole?
DNA Strand breaks and structure alteration
What is the spectrum of Metronidazole?
- All anerobes except Actinomycess, Propionibacterium acnes, Lactobacilli
- Inactive against aerobes
- Antiprotozoal and amebicidal
How is Metronidazole dosed?
- Anaerobic infections: 500 mg Q8H
- C. diff: 500 mg PO or IV Q8H
- IV = PO
What are the adverse effects of Metronidazole?
- Metallic tase in mouth
Why should you avoid Ritonivir (gieven for HIV) when giving Metronidazole?
Disulfarim effect causes N/V with the alcohol in ritonavir
How should you counsel a patient receiving Metronidazole?
- Avoid alcohol
- Metallic taste = goes away over time
What is the brand name for Fosfomycin?
What is the spectrum for Fosfomycin (Monurol)?
- No G +
- Some E. coli (4)
- Some E. cloacae (8)
What is the dose for Fosfomycin (Monurol)?
- 3 gram PO satchet
- One time dose
What is Fosfomycin (Monurol) used for?
Single dose therapy for Carbapenemase producing enterobacteriaceae in the urine = UTI
What is the brand name for Fidaxomicin?
What is the use for Fidaxomicin (Dificid)?
ONLY antibiotic ascoaited C. diff
Why is Fidaxomicin (Dificid) not commonly used?
What is a normal dose of Fidaxomicin (Dificid)?
200 mg PO BID
What type of antibiotic is Fidaxomicin (Dificid) similar to?
What is the brand name for Colistin or Polymyxin E?
What is the MOA for Colistin/Polymixin E (Colymycin-M)?
Polypeptide that acts as a detergent
How is Colistin/Polymixin E (Colymycin-M) administered?
IV, inhalation or topical
When is Colistin/Polymixin E (Colymycin-M) used?
Multidrug resistant gram negative bacilli (VAP)
What is the spectrum for Colistin/Polymixin E (Colymycin-M)?
- E. coli (4)
- Acinitobacter (2)
- Pseudomonas (2)
What is the route of administration for Colistin/Polymixin E (Colymycin-M)?
What is the primary PK/PD parameter for Colistin/Polymixin E (Colymycin-M)?
Is Colistin/Polymixin E (Colymycin-M) bacteriocidal or static?
What is the main use for Colistin/Polymixin E (Colymycin-M)?
- MDR Gram negative bacilli associated with VAP
- Often associated with ventilators or nosocomial
What is a normal dose of Colistin/Polymixin E (Colymycin-M)?
- 5 mg/kg (IBW) Loading dose
- 250 mg IV Q8H
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